Скачать или смотреть Arc Test | Midportion Achilles Tendinopathy

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Diagnosing Achilles tendinopathy might seem straightforward, but there are countless differential diagnoses such as retrocalcaneal bursitis, bone abnormalities such as a painful os trigonum, tarsal tunnel syndrome, neuritis of the sural nerve, amongst others. Furthermore, we have to distinguish between an irritation of the tendon sheath—often caused by friction overload—and the tendon itself, which are both managed differently.

The ARC test had a sensitivity of 42 percent and a specificity of 88 percent in the detection of mid-portion Achilles tendinopathy. We have to be careful, though, as the included studies used ultrasound as the gold standard, and we must keep in mind that many asymptomatic tendons will show pathology. For this reason, we give this test a rather weak clinical value.

To conduct the test, have the patient lie prone on the examination table, with the ankles clear of the table. First, the clinician palpates the Achilles tendon in a distal-to-proximal direction, between two and six centimeters above its insertion into the calcaneum, gently squeezing the tendon between the index finger and the thumb, feeling for localized thickening of the tendon.

Afterwards, the palpating fingers remain on the area of swelling, and the patient is asked to dorsiflex and plantarflex the ankle. In tendinopathy of the main body of the tendon, the area of swelling moves with dorsiflexion and plantarflexion.

If an area of swelling cannot be identified, an area in the tendon three centimeters from the calcaneal insertion is palpated during the movement. If the palpable thickening does not move but stays relatively still, with palpable crepitations, the tendon sheath might be suspected as the area of injury. The use of a stethoscope might be a helpful addition in case crepitations cannot be felt.

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